Provider Demographics
NPI:1972165777
Name:JESTEEN, TIPSY (CRNP)
Entity Type:Individual
Prefix:
First Name:TIPSY
Middle Name:
Last Name:JESTEEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TIPSY
Other - Middle Name:KIZHAKKEKARA
Other - Last Name:JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N BUCKSTOWN RD STE E-206
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1815
Mailing Address - Country:US
Mailing Address - Phone:215-741-1963
Mailing Address - Fax:215-741-1914
Practice Address - Street 1:100 N BUCKSTOWN RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1815
Practice Address - Country:US
Practice Address - Phone:215-741-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019132363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner